Peptic Ulcer: Causes, Symptoms, Diagnosis, Treatment, and Prevention
An ulcer occurs when the tissue is damaged by an infection, inflammation, or injury. If left untreated, ulcers can cause pain, discomfort, and sometimes even serious complications. They can affect the skin, the stomach, the mouth, and the genitals. Here are a few ways in which ulcers can cause pain, discomfort, and sometimes serious complications.
Peptic ulcers are sores that develop in the stomach, lower esophagus, or small intestine as a result of an infection caused by the bacteria Helicobacter pylori (H. pylori) and stomach acid erosion. It is possible to diagnose peptic ulcers with endoscopy, blood tests, and breath tests. Peptic ulcers can be treated by medications, lifestyle changes, and surgery. Peptic ulcers can cause burning abdominal pain, nausea, vomiting, and bleeding. Peptic ulcers can be prevented by avoiding risk factors, such as smoking, alcohol, and NSAIDs.
Types of Peptic Ulcers
There are three types of peptic ulcers, depending on the location of the sore:
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Gastric ulcers: These are ulcers that occur on the inside of the stomach.
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Duodenal ulcers: These are ulcers that occur on the inside of the upper portion of the small intestine, called the duodenum.
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Esophageal ulcers: These are ulcers that occur on the lower part of the esophagus, the tube that connects the mouth to the stomach.
Causes of Peptic Ulcers
The main causes of peptic ulcers are:
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Infection with H. pylori is a bacterial infection that can occur in your stomach and small intestine. It can cause inflammation of the mucous layer protecting your digestive tract. Due to this, stomach acid and digestive enzymes may damage the lining more easily.
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These are nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen. As a result, they can reduce prostaglandins, which protect the stomach and small intestine from acid and injury. People who use these drugs frequently or for a long time are at increased risk of developing peptic ulcers.
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Several other factors can contribute to stomach cancer, such as smoking, alcohol, stress, radiation therapy, and diseases that affect the stomach or small intestine, such as Crohn's disease and Zollinger-Ellison syndrome.
Symptoms of Peptic Ulcers
In most cases, peptic ulcers cause burning abdominal pain that extends from the navel to the chest. Symptoms of peptic ulcers range in severity and frequency. The pain can be worse when the stomach is empty, and it can be relieved by eating, drinking, or taking antacids. During the night or between meals, the pain can also become worse.
Other symptoms of a peptic ulcer include:
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Changes in appetite: Peptic ulcers can cause a feeling of fullness, bloating, or belching after eating. They can also cause a loss of appetite or weight loss.
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Vomiting or nausea: Peptic ulcers can cause nausea, which refers to feeling sick or uncomfortable in the stomach. They can also cause vomiting, which is the forceful expulsion of stomach contents through the mouth. Often, the vomit contains blood or looks like coffee grounds, which indicates bleeding from the ulcer.
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It is possible for peptic ulcers to bleed when they are eroded by stomach acid, or injured by a foreign object, such as a pill. As a result of bleeding from a peptic ulcer, dark or black stools can result, known as melena. Bleeding can also cause anemia, a condition in which the blood has a low number of red blood cells. Shortness of breath, fatigue, and weakness are some of the symptoms of anemia.
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The presence of peptic ulcers can lead to serious complications if left untreated. Perforation is the formation of a hole in the stomach or small intestine; obstruction is the obstruction of the passage of food or liquids through the digestive tract; and penetration is when the ulcer extends into nearby organs, such as the liver or pancreas.
Diagnosis of Peptic Ulcers
First, the doctor may take a medical history and perform a physical examination to diagnose peptic ulcers. Symptoms, medications used, smoking and drinking habits, and a family history of peptic ulcers may be discussed with the doctor. Additionally, the doctor may look for signs of anemia, including pale skin, a rapid pulse, and low blood pressure.
The doctor may then order one or more of the following tests to confirm the diagnosis and to determine the cause and the severity of the peptic ulcer:
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During an endoscopy, the doctor inserts a thin, flexible tube with a camera and light at the end into the stomach and small intestine through the mouth. The doctor can see the lining of the digestive tract and look for ulcers, inflammation, bleeding, or other abnormalities. In addition to taking a biopsy, a small sample of tissue is also available to the doctor for further examination.
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In blood tests, certain substances are measured, such as red blood cells, hemoglobin, and antibodies. They can help detect anemia, bleeding, and H. pylori infection.
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The patient must swallow a capsule or liquid containing a substance that is broken down by H. pylori as part of the breath test, which indicates the presence of H. pylori infection. The patient then breathes into a bag or a device that measures the amount of carbon dioxide in the breath.
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Tests on the stool can help detect blood, H. pylori infection, or other bacteria or parasites that can cause peptic ulcers.
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A peptic ulcer imaging test uses X-rays, ultrasounds, or other techniques to create pictures of the inside of the stomach. Imaging tests can help detect complications such as perforation, obstruction, or penetration of the ulcer.
Treatment of Peptic Ulcers
Treatment of peptic ulcers depends on its cause, severity, and complications. The main goals of treatment are to heal the ulcers, prevent them from coming back, and avoid complications.
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Medications: There are several types of medications that can help treat peptic ulcers, such as:
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A combination of two or more antibiotics may be necessary for several weeks, along with other medications to reduce acid and protect the stomach and small intestine lining.
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PPIs are drugs that block the production of stomach acid. They can heal ulcers and prevent them from recurring. Examples include omeprazole, lansoprazole, and esomeprazole.
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In addition to reducing stomach acid, H2 blockers also help heal ulcers and prevent them from returning. Examples of H2 blockers include ranitidine, cimetidine, and famotidine.
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In addition to providing quick relief from pain and discomfort, antacids don't heal ulcers or prevent them from returning. You shouldn't take antacids for longer than two weeks without first consulting your doctor.
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Cytoprotective agents: These drugs coat and protect the lining of your stomach and small intestine. They can help heal ulcers and prevent them from recurring. Examples of cytoprotective agents are sucralfate, bismuth subsalicylate, and misoprostol.
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It is rarely necessary to undergo surgery to treat peptic ulcers unless they cause severe bleeding, perforation, obstruction, or cancer. It is possible to remove part of your stomach or small intestine, or to bypass the ulcer by creating a new connection between your stomach and small intestine.
Prevention of Peptic Ulcers
You can prevent peptic ulcers by avoiding or limiting the factors that can cause or worsen them, such as:
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Infection with H. pylori can be reduced by practicing good hygiene, such as washing your hands frequently, drinking clean water, and eating cooked foods. If you have been diagnosed with H. pylori infection, you should complete the prescribed antibiotic course and follow up with your doctor to make sure the infection is gone.
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NSAIDs: When taking NSAIDs, you should only take them when necessary and at the lowest effective dose for the shortest period of time. You should also take them with food or milk, or use a different type of pain reliever, such as acetaminophen. Before taking any NSAIDs, consult your doctor if you have a history of peptic ulcers or are at higher risk of developing them. While taking NSAIDs, your doctor may prescribe you a PPI, an H2 blocker, or a cytoprotective agent.
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You should quit smoking or seek assistance if you smoke. Smoking can increase stomach acid production, impair ulcer healing, and increase complications.
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You should limit or avoid alcohol consumption if you have peptic ulcers or take medication for them. Alcohol can irritate and erode the lining of your stomach and small intestine.
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Stress: Peptic ulcers are not caused by stress, but it can worsen their symptoms. If you suffer from chronic or severe stress that affects your daily life, you should seek professional help. Meditation, yoga, or breathing exercises can help you manage your stress levels.
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Peptic ulcers cannot be prevented or cured by a specific diet, but certain foods and beverages may aggravate your symptoms, including spices, acidics, and fat, as well as coffee, tea, chocolate, and carbonated drinks. You should avoid or limit these foods and beverages, and eat a balanced and nutritious diet that suits your preferences and needs. You should also eat smaller and more frequent meals, and avoid eating late at night or before going to bed.
